Aditya Saini1, Yuhning L Hu2, Vigneshwar Kasirajan3, Frederick T Han4, Muhammad Z Khan2, Luke Wolfe3, Sampath Gunda2, Jayanthi N Koneru2, Kenneth A Ellenbogen2. 1. Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia. Electronic address: dradityasaini@gmail.com. 2. Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia. 3. Division of Cardiac Surgery, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia. 4. Division of Cardiology, University of Utah Health Sciences Center, Salt Lake City, Utah.
Abstract
BACKGROUND: Minimally invasive surgical atrial fibrillation (AF) ablation (MISAA) delivers radiofrequency energy via a thoracoscopic approach to perform pulmonary vein isolation and left atrial ganglionic plexi ablation. Data on long-term outcomes of MISAA are lacking. OBJECTIVE: We report 5-year follow-up data from a prospective cohort of patients who underwent MISAA at a single center. METHODS: One hundred nine consecutive patients (60 paroxysmal, 49 persistent; mean age 62.7 ± 9.3 years) underwent MISAA with left atrial appendage exclusion by a single surgeon between 2006 and 2012. Patients were followed with transtelephonic monitoring at 1, 6, and 12 months and annually thereafter for up to 5 years. Recurrence was defined as any atrial tachyarrhythmia lasting ≥30 seconds from 90 days after surgery onward. RESULTS: Mean follow-up duration was 1738.5 ± 661.5 days. Single-procedure success rate was 38% (37 of 98 patients). Atrial arrhythmias occurred in 22%, 42%, 55%, 59%, and 62% of patients by 1, 2, 3, 4, and 5 years. Seventy-eight (79.6%) patients remained AF free with or without additional interventions including catheter ablation, antiarrhythmic drugs, or cardioversion. There was no significant difference in AF-free survival between paroxysmal and persistent AF groups (P = .725). Multivariate analyses showed hypertension to be a significant predictor of AF recurrence (odds ratio 6.6, confidence interval 1.41-30.80; P = .016). Five (5.1%) patients had a stroke or transient ischemic attack during follow-up. CONCLUSION: AF-free survival was 38% at 5 years after MISAA. A total of 79.6% of patients remained AF free with or without additional intervention. Patients may have an ongoing risk of stroke even in the absence of AF recurrences.
BACKGROUND: Minimally invasive surgical atrial fibrillation (AF) ablation (MISAA) delivers radiofrequency energy via a thoracoscopic approach to perform pulmonary vein isolation and left atrial ganglionic plexi ablation. Data on long-term outcomes of MISAA are lacking. OBJECTIVE: We report 5-year follow-up data from a prospective cohort of patients who underwent MISAA at a single center. METHODS: One hundred nine consecutive patients (60 paroxysmal, 49 persistent; mean age 62.7 ± 9.3 years) underwent MISAA with left atrial appendage exclusion by a single surgeon between 2006 and 2012. Patients were followed with transtelephonic monitoring at 1, 6, and 12 months and annually thereafter for up to 5 years. Recurrence was defined as any atrial tachyarrhythmia lasting ≥30 seconds from 90 days after surgery onward. RESULTS: Mean follow-up duration was 1738.5 ± 661.5 days. Single-procedure success rate was 38% (37 of 98 patients). Atrial arrhythmias occurred in 22%, 42%, 55%, 59%, and 62% of patients by 1, 2, 3, 4, and 5 years. Seventy-eight (79.6%) patients remained AF free with or without additional interventions including catheter ablation, antiarrhythmic drugs, or cardioversion. There was no significant difference in AF-free survival between paroxysmal and persistent AF groups (P = .725). Multivariate analyses showed hypertension to be a significant predictor of AF recurrence (odds ratio 6.6, confidence interval 1.41-30.80; P = .016). Five (5.1%) patients had a stroke or transient ischemic attack during follow-up. CONCLUSION:AF-free survival was 38% at 5 years after MISAA. A total of 79.6% of patients remained AF free with or without additional intervention. Patients may have an ongoing risk of stroke even in the absence of AF recurrences.
Authors: Sacha P Salzberg; Wim-Jan van Boven; Christophe Wyss; David Hürlimann; Ivano Reho; Thomas Zerm; Georg Noll; Maximilian Y Emmert; Roberto Corti; Jürg Grünenfelder Journal: J Atr Fibrillation Date: 2019-02-28